1161: CANNABIS INTOXICATION: A RARE CAUSE OF LACTIC ACIDOSIS

Abstract

Introduction: Lactic acidosis is common in critically ill patients and has a variety of etiologies. While sepsis, hemorrhage, and shock are the most common causes of lactic acidosis, a subset of patients have no obvious cause. Drug and medication toxicity remains a rare cause of lactic acidosis that providers often fail to recognize. Here, we present a rare case of lactic acidosis due to acute marijuana intoxication. Description: A 26-year-old male with no prior history of marijuana use was brought into the emergency department with complaints of shortness of breath and palpitations after ingesting ice cream containing cannabis. Per EMS, the patient was found screaming for help due to his symptoms but evidently with altered mentation. On arrival, the patient was febrile to 101.9 F with a heart rate of 156 bpm; he was normotensive and saturating well on room air with a normal respiratory rate. Laboratory studies were significant for an elevated lactate level of 4, a white blood cell count of 11, and a urine drug screen positive for THC. The patient was given empiric broad-spectrum antibiotics, 2 liters of lactated ringer’s, and IV naloxone with no improvement in mental status. Studies and physical examination did not reveal any source of infection. After careful monitoring, the patient’s mental status recovered and lactic acid cleared with supportive measures. The patient was later discharged safely home with appropriate follow-up. Discussion: Poisoning is one of the leading causes of injury-related casualties in the United States, and lactic acidosis is a widely used predictor to stratify patients who are at increased risk for mortality. Elevated lactate levels result from an imbalance between lactate metabolism and production. Synthetic cannabinoids have been established as rare causes of lactic acidosis. Chronic marijuana use has been associated with lactic acidosis by way of thiamine deficiency and gastrointestinal beriberi corrected promptly with vitamin administration. There are no reported cases linking acute marijuana use and lactic acidosis development in the absence of infection, hemodynamic compromise, or seizures. It is important to keep drug ingestion and intoxication in mind as important causes of lactic acidosis in the absence of other apparent etiologies.